Transcatheter Aortic Valve Implantation in Dialysis Patients

Rau, Simon; Lange, Philipp; Kupatt, Christian; Steinbeck, Gerhard; Fischereder, Michael; Schönermarck, Ulf

doi:10.1159/000335781

Cited by 24 publications

(16 citation statements)

References 33 publications

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“…In the present study, advanced CKD was associated with worse outcomes (mortality, bleeding, and stroke) in high‐risk TAVR patients. This is in line with previous studies demonstrating that advanced CKD is an independent risk factor for mortality, stroke, and bleeding events in TAVR patients . The findings herein corroborate these earlier reports and the observation that mortality, bleeding events, and stroke cluster in this cohort.…”

Section: Discussionsupporting

confidence: 93%

Advanced chronic kidney disease: Relationship to outcomes post‐TAVR, a meta‐analysis

Makki

Lilly

2018

Clinical Cardiology

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Chronic kidney disease (CKD) is associated with worse outcomes in high-surgical-risk patients undergoing transcatheter aortic valve replacement (TAVR). However, it is unclear whether this relationship is apparent in lower-surgical-risk patients. We sought to analyze existing literature to assess whether or not advanced CKD is associated with increased mortality or a greater incidence of adverse events (specifically major stroke, bleeding, and vascular complications). We searched PubMed and Embase (2008-2017) for relevant studies. Studies with <1 year follow-up and those not evaluating advanced CKD or outcomes post-TAVR were excluded. Our co-primary endpoints were the incidence of short-term mortality (defined as in-hospital or 30-day mortality) and long-term mortality (1 year). Our secondary endpoints included incidence of major stroke, life-threatening bleeding, and major vascular complications. Eleven observational studies with a total population of 10709 patients met the selection criteria. Among patients with CKD there was an increased risk of short- and long-term mortality in high-surgical-risk patients who underwent TAVR (hazard ratio [HR]: 1.51, 95% confidence interval [CI]: 1.22-1.88 and HR: 1.56, 95% CI: 1.38-1.77, respectively; P < 0.01). However, there was no association between CKD and mortality in low- to intermediate-risk patients (HR: 1.35, 95% CI: 0.98-1.84, P = 0.06 in short-term and HR: 1.08, 95% CI: 0.92-1.27, P = 0.34 in long-term). In low- to intermediate-risk TAVR patients, advanced CKD is not associated with increased mortality or poorer safety outcomes. These findings should be factored into the clinical decision-making process regarding TAVR candidacy.

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Section: Discussionsupporting

confidence: 93%

Advanced chronic kidney disease: Relationship to outcomes post‐TAVR, a meta‐analysis

Makki

Lilly

2018

Clinical Cardiology

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“…In our study, 6‐month survivability was 74.4%. This was similar to Rau et al who reported 6‐month survival rates of TAVR in 10 high‐risk chronic hemodialysis patients to be 80%. A collaborative report from four European centers reported outcomes of 33 patients on hemodialysis after TAVR with a 1‐year survival rate of only 54.8% .…”

Section: Discussionsupporting

confidence: 90%

The outcomes of transcatheter aortic valve replacement in a cohort of patients with end‐stage renal disease

Kim

Adeniyi

Thourani

et al. 2016

Cathet Cardio Intervent

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Objectives: To examine whether transcatheter aortic valve replacement (TAVR) is a safe and effective treatment option for aortic stenosis in patients with end-stage renal disease (ESRD). Background: Patients with ESRD undergoing surgical aortic valve replacement have an operative mortality approaching 20% and a 10-year survival of approximately 12%. We investigated whether TAVR is a more reasonable option. Methods: This is a multicenter, retrospective study of all patients with ESRD who underwent TAVR in 8 institutions between 12/2011 and 02/2013. Demographic characteristics, (2016) mortality, major, and minor complications were evaluated. Outcomes were stratified by operative approach. Results: Forty-three patients with a mean age 76.2 6 11.0 years and a mean STS predicted risk of mortality of 15.53 6 8.70% underwent TAVR. Mean duration of dialysis was 45.2 6 52.3 months (median 29.5 months). Transfemoral (TF) TAVR was performed in 31/43 (72.1%), transapical in 11/43 (25.6%), and transaortic in 1/ 43 (2.3%). Operative mortality was 14.0% (6/43) with TF mortality 6.5% (2/31) and 33.3% (4/12) in non-TF patients. Six-month mortality was 11/43 (25.6%: 16.1% TF, 50.0% non-TF). Complications included stroke in 2.3% (1/43) and life-threatening or major bleeding in 14.0% (6/43). Discharge to another healthcare facility was 27.0% (10/37). Readmission within 30 days of procedure for any cause was 18.9% (7/37). Conclusions: Patients with ESRD who undergo TAVR are at high risk for mortality and complications. TAVR outcomes are comparable to but not substantially better than those with SAVR. Transfemoral TAVR seems to be at least as safe and effective as the current standard SAVR in patients undergoing aortic valve replacement. V C 2016 Wiley Periodicals, Inc.

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“…It is interesting to note that TAVR does not increase mortality in patients with ESRD and is therefore an attractive option in the dialysis patient . One can argue that in subjects with ESRD, where all the functions of the kidney are met by renal replacement therapy (RRT), contrast‐mediated and athero‐embolic effects have minimal adverse impact.…”

Section: Pathogenesis and Risk Factorsmentioning

confidence: 99%

Acute kidney injury post–transcatheter aortic valve replacement

Ram

Mezue

Pressman

et al. 2017

Clinical Cardiology

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Transcatheter aortic valve replacement (TAVR) is a treatment option in high-risk patients with severe aortic stenosis who are not surgical candidates. In light of emerging evidence, it is being increasingly performed even in intermediate-risk patients in recent years. Patients who develop acute kidney injury (AKI) following TAVR are known to have worse outcomes. The objective of this concise review was to identify the prevalence and the impact of AKI following TAVR on patient outcomes by including the most recent literature in our search. After a thorough search on MEDLINE, Google Scholar, and PubMed, we included all literature relevant to AKI following TAVR. We found that AKI was caused by a variety of reasons, such as hemodynamic instability during rapid pacing, blood transfusion, periprocedural embolization, and use of contrast medium, to name a few. In patients who developed AKI following TAVR, 30-day and 1-year mortality were increased. Further, in these patients, length and cost of hospital stay were increased as well. Preventive measures such as optimal periprocedural hydration, careful contrast use, and techniques to prevent embolization during device implantation have been tried with limited success. Given that TAVR is expected to be increasingly performed, this review aimed to summarize the rapidly expanding currently available literature in an effort to reduce procedural complications and thereby improve patient outcomes.

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Transcatheter Aortic Valve Implantation in Dialysis Patients

Cited by 24 publications

References 33 publications

Advanced chronic kidney disease: Relationship to outcomes post‐TAVR, a meta‐analysis

Advanced chronic kidney disease: Relationship to outcomes post‐TAVR, a meta‐analysis

The outcomes of transcatheter aortic valve replacement in a cohort of patients with end‐stage renal disease

Acute kidney injury post–transcatheter aortic valve replacement

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